9510-100 (SFD)If -t
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. �y' / t
tI' A:+ `J J (/31[96
License # Lib, Cass Exp. D�ate9
Date Signature of Contractor /i'��
OWNER -BUILD! XDECL�A�?iTION�
I hereby affirm that I, am exempt �om, tt�e S3ontractor's .License Law for the
following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
() I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
() I am exempt under, Section B&P.C. for this reason
Date Signature of.Owner
WORKER'S'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
() I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
:"( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are: .
Carrier Policy No.
(This section need not be, completed if the permit valuation rris�for $100.00 or less).
() Icer�y(t� INhAthe performance of the work for whichCtl�is '!!mit is issued,
I shall not employ any person in any manner so as to become subject to the
Workers' compensation laws of California, and agree that if I should become
subject 'to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
J
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cast of compensation, damages as provided for in Section 3706
Of the Labor Code; interest and attorney's fees.
IMPORTANT Application is.hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set.foith on his application.
1. Each "person, upon'whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of:19.dan W4116phs; officers, agents and employees:--°
2. Any permit issued as a result of this application becomes null ah�void i
work is not commenced .within 180 days :from date of issuance lofjlsuch�
permit, or cessation of work for 180 days will subject permit to cant i Illation.
I certify that I have read this application and state that the. above Informatiom is,
correct. I agree to comply with all City, a _
nd State'laws relating to the build!ng•
construction, and hereby authorize representativvees'of this City to enter-,pon the
above-mentioned property for inspection purposes: "" `'
,
� Signature (Owner/Ag � Data%r
ALC r,:; rt,
BUILDING PERMIT('�_����
PERMITS
DATE iviil95
VALUATION • $13_1MT
LOT' ,��� :TRACT 261 S).
�'
JOB SITE ADDRESS
APN
u.,Flet► NICE
617=%x-41 9
OWNER
CONTRACTOR
CEN'1�J'R l:tUMlI:S COMMUN ES
C: 131tiT1_i'RY;FIoMES CC)N11KUNITIFS
1533 SGUTH D ST1MT 0200
1535 SflEi'M D STREE 1` x#200
SAN BER.NA-i` D NO CA, 92409
SAN 13E WARD1'4, CA. 9,2408
0AQ)gR -6ffl_1 I
DESIGNER/ENGINEER'
(9")381.6007
USE OF PERMI1;-ING E" F-MIML.Y PWILLING
? .PiiNNAKlwBf't. COVE. AT f;,AK.i+,.LA QUINTA.
PLAN 1QA-
FEE DESCRIPTION
FEES
'11"M C`O1VS'FXUC TION 2,19S.00 SF
C.ARA.GWCAP2 ORT 1i43,.00:a:C
SUMATED NST OF L��,S�'€�UCfION
.13:x, 791.30
�� g�` R��'R A y
P�S:t.R MIT .@�.:IJYJ SSJ;F'A A.111S'
PLAN Cf 3r!'iti FM x[if -fila()-A 9-3I R' $629.37
C0NTI RUC°crt, NFE 100.000-413-000 $7.51,50
MECHANICAL FB- 1.01 -000 -421 -OW $53,50
OO ECTRIGAI., •101-000-4,0-000
1$00-419(3wUVa 0 $157.50
ST CYNG MOTION FEE -` ID '. 200-00042411400 13. is
45RAiii,�t�'i FPF 101-000423-000
9;131;'RAbS'I UCTIJRl~ FEE 225-000.443-342 $2,965.30
PraPrIn.:PLAN 10:1.-000-491=341
r1wr IN PUS11C'PT ACFS - RESITy 701-000.155-000 5179:4b'
SUll-lUrAL CONSTRUC1101I.ANO PLAN CHECK
SiI,847.02
U LESS PRE -PAID FEES
50.00
1.6 1995. TQTAL, PEKh1 FEES DUE NOW
146-94102
TOTAI.`K03.1✓CT P'V011'4 .n;t.vs ,
4,847.02 .
RECEIPT
DATE -
BV, .
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs /
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel /
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath (�
Final
Final /
BLOCKWALL APPROV LS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Linesf
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans'
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation.
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final 3 7 9G
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 11/15/95 APN # 617-790-029
No. 13892 Jurisdiction La Quinta
Owner NameCentury Homes Communities Permit #
No. 47850 Street Via Nice Log #
City La Quinta Zip 92253 Study Area 123
Tract # 26152 Lot # 29 Square Footage 2195
Type of Development Single Family Residence No. of Units 1
Comments
Address correction from 47750 to 47850 per Ureg Butler from the City of La Quinta.
Correction made on 8/4/99 by Juanita Green.
At the present time, the Desert- •Sands. Unified School District does . not. collect fees on
garages/carports, covered patios/walkways, `residential additions under _500 square feet, detached
accessory structures or replacement mobilehomes. It has beeri'de`teririined'th_e�above-named owner is
exempt -from. school fees:at this�time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government.Code 53080
in the amount of 1.72 x 2,195 or $ 3,775.40' r _
the property listed above and that building permits and/or. Certificates Rf Occupancy for
this square footage in this proposed project may now be issued.,
. '_, fes. � � • v .
Fees Paid By Century Homes Spinnaker Cove, L.P. Teiephone'7 90973 8 1=6007
Name on the check
By Dolores A. Ballesteros ,
Superintendent .
Fee collected;/exempted by , Pauline Pearson Payment Received $3,775.40
-;cil, Check No: 100754
v
Signature
i
Collector: Atta h a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy -_ Applicant/Receipt Copy - Accounting
i
ta
FACSIMILE
.'..
To: Peggy Reyes
Of: Desert Sands Unified School District
Fax: 760/771-8522
Phone: 760,71=8515
Pages: - 2, including this cover sheet.
Date: August,3;1999
Dear Peggy,
It has come to my attention that -in November 1995,,the Building Department incorrectly
issued a.permit for a single family dwelling at 47-750 Via Nice. That is not a valid
address for that street. The correct address should have been 47-850 Via Nice (APN 617-
790-029).
A copy of your certificate #13892 follows. You may want to correct your records for
possible future permits at this property.
Thank you, .
Greg Butler `
From the desk of...
Greg Butler
Counter Technician
" City of La Quinta Building Department
n PO Box 1504
78-495 Calle Tampico
La Quinta, CA 92253
760-777-7012
Fax: 760-777-7011